title: Malaria prevention reduces in-hospital mortality among severely ill tuberculosis patients: a three-step intervention in Bissau, Guinea-Bissau.
abstract: BACKGROUND
  Malaria and Tuberculosis (TB) are important causes of morbidity and mortality in Africa. Malaria prevention reduces mortality among HIV patients, pregnant women and children, but its role in TB patients is not clear. In the TB National Reference Center in Guinea-Bissau, admitted patients are in severe clinical conditions and mortality during the rainy season is high. We performed a three-step malaria prevention program to reduce mortality in TB patients during the rainy season.
  
  
  METHODS
  Since 2005 Permethrin treated bed nets were given to every patient. Since 2006 environmental prevention with permethrin derivates was performed both indoor and outdoor during the rainy season. In 2007 cotrimoxazole prophylaxis was added during the rainy season. Care was without charge; health education on malaria prevention was performed weekly. Primary outcomes were death, discharge, drop-out.
  
  
  RESULTS
  427, 346, 549 patients were admitted in 2005, 2006, 2007, respectively. Mortality dropped from 26.46% in 2005 to 18.76% in 2007 (p-value 0.003), due to the significant reduction in rainy season mortality (death/discharge ratio: 0.79, 0.55 and 0.26 in 2005, 2006 and 2007 respectively; p-value 0.001) while dry season mortality remained constant (0.39, 0.37 and 0.32; p-value 0.647). Costs of malaria prevention were limited: 2€/person. No drop-outs were observed. Health education attendance was 96-99%.
  
  
  CONCLUSIONS
  Malaria prevention in African tertiary care hospitals seems feasible with limited costs. Vector control, personal protection and cotrimoxazole prophylaxis seem to reduce mortality in severely ill TB patients. Prospective randomized trials are needed to confirm our findings in similar settings.
authors.affiliation: Clinic of Pediatric Hematology-Oncology, Department of Pediatrics, University of Padova, Padova, Italy. rcolombatti@gmail.com
authors.forename: Raffaella
authors.initials: R
authors.lastname: Colombatti
authors.forename: Martina
authors.initials: M
authors.lastname: Penazzato
authors.forename: Federica
authors.initials: F
authors.lastname: Bassani
authors.forename: Cesaltina Silva
authors.initials: CS
authors.lastname: Vieira
authors.forename: Antonia Araujo
authors.initials: AA
authors.lastname: Lourenço
authors.forename: Fina
authors.initials: F
authors.lastname: Vieira
authors.forename: Simone
authors.initials: S
authors.lastname: Teso
authors.forename: Carlo
authors.initials: C
authors.lastname: Giaquinto
authors.forename: Fabio
authors.initials: F
authors.lastname: Riccardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage; D018890:Chemoprevention / Q000379:methods; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D057148:Insecticide-Treated Bednets; D007306:Insecticides / Q000378:metabolism; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000379:methods; D026023:Permethrin / Q000378:metabolism; D016019:Survival Analysis; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D014376:Tuberculosis / Q000453:epidemiology* / Q000401:mortality*; D055815:Young Adult
chemical_list: D000962:Antimalarials; D007306:Insecticides; D026023:Permethrin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination